Peter Bollars, Hans Feyen, Dinesh Nathwani, Ali Albelooshi, Max Ettinger, Ronny De Corte, Martijn G. M. Schotanus
Purpose
The purpose of this study was to investigate the impact of pre- and postoperative changes in Coronal Plane Alignment of the Knee (CPAK) classification on patient-reported outcome measures (PROMs) and to determine the rate of CPAK classification change in patients undergoing either conventionally aligned total knee arthroplasty (CTKA) or imageless robotic-assisted total knee arthroplasty (RATKA). We hypothesised that PROM improvements would be comparable regardless of whether postoperative CPAK classification was preserved (“In-the-box”) or altered (“Out-of-the-box”) in both surgical techniques.
Methods
In this prospective randomised controlled trial, 180 patients were assigned to either CTKA or RATKA. CPAK classification was assessed pre- and postoperatively. PROMs were collected at baseline, 3, and 12 months postoperatively, including the Knee Society Score, Oxford Knee Score, visual analog scale (VAS) for daytime and night time pain, EuroQol-5D (index and VAS), and patient satisfaction.
Results
Baseline characteristics were similar between groups. Native CPAK classification was preserved in 31% of CTKA and 41% of RATKA patients. Postoperatively, CPAK II was most common (40% CTKA and 49% RATKA), followed by CPAK V. Both groups showed significant improvements in all PROMs at 3- and 12-months, regardless of CPAK classification change, and operative technique.
Conclusions
Short-term functional outcomes following TKA were not significantly influenced by In-the-box or Out-of-the box CPAK classification. Both CTKA and RATKA yielded comparable PROM improvements. Although altered CPAK often required greater soft-tissue release, especially in CTKA, this did not affect outcomes, suggesting alignment strategy should prioritise individual anatomy and soft-tissue balance over strict CPAK matching.
{"title":"Postoperative changes in CPAK-classification do not significantly influence patient-reported outcome measures following conventional or robotic-assisted total knee arthroplasty: A randomised controlled trial","authors":"Peter Bollars, Hans Feyen, Dinesh Nathwani, Ali Albelooshi, Max Ettinger, Ronny De Corte, Martijn G. M. Schotanus","doi":"10.1002/ksa.12740","DOIUrl":"10.1002/ksa.12740","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The purpose of this study was to investigate the impact of pre- and postoperative changes in Coronal Plane Alignment of the Knee (CPAK) classification on patient-reported outcome measures (PROMs) and to determine the rate of CPAK classification change in patients undergoing either conventionally aligned total knee arthroplasty (CTKA) or imageless robotic-assisted total knee arthroplasty (RATKA). We hypothesised that PROM improvements would be comparable regardless of whether postoperative CPAK classification was preserved (“In-the-box”) or altered (“Out-of-the-box”) in both surgical techniques.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this prospective randomised controlled trial, 180 patients were assigned to either CTKA or RATKA. CPAK classification was assessed pre- and postoperatively. PROMs were collected at baseline, 3, and 12 months postoperatively, including the Knee Society Score, Oxford Knee Score, visual analog scale (VAS) for daytime and night time pain, EuroQol-5D (index and VAS), and patient satisfaction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Baseline characteristics were similar between groups. Native CPAK classification was preserved in 31% of CTKA and 41% of RATKA patients. Postoperatively, CPAK II was most common (40% CTKA and 49% RATKA), followed by CPAK V. Both groups showed significant improvements in all PROMs at 3- and 12-months, regardless of CPAK classification change, and operative technique.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Short-term functional outcomes following TKA were not significantly influenced by In-the-box or Out-of-the box CPAK classification. Both CTKA and RATKA yielded comparable PROM improvements. Although altered CPAK often required greater soft-tissue release, especially in CTKA, this did not affect outcomes, suggesting alignment strategy should prioritise individual anatomy and soft-tissue balance over strict CPAK matching.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level I.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 9","pages":"3333-3340"},"PeriodicalIF":5.0,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Robert B. Baldwin, Samarth V. Menta, Mark Kurapatti, Dominic Carreira, Shane Nho, Andrew Wolff, John Christoforetti, John Salvo, Dean Matsuda, Anil S. Ranawat
Purpose
The present study aims to describe epidemiological, diagnostic and surgical data for a large group of patients undergoing hip arthroscopy between 2018 and 2023. We also explore how these trends compare to previous cohorts, particularly the 2014–2017 Multicenter Arthroscopic Study of the Hip (MASH) study. In response to the rapid growth of hip arthroscopy literature, we hypothesize that surgeons are operating on patients with a lower average body mass index (BMI), younger age, less severe reported symptoms at the time of surgery, and shorter preoperative symptom duration.
Methods
The MASH database was searched for patients who underwent hip arthroscopy for treatment of FAI between 2018 and 2023, and had demographic data available in the registry. Standardized data included demographics, symptoms, imaging, intraoperative diagnoses (labral tears, cartilage lesions) and patient-reported outcome measures (International Hip Outcome Tool 12-item [iHOT-12], modified Harris Hip Score [mHHS], HOS, Visual Analogue Scale, 12-item Short Form Health Survey, Patient-Reported Outcomes Measurement Information System).
Results
Our study found that patients who elected to undergo hip arthroscopy between 2018 and 2023 at eight different US-based sites were, on average, 34.3 years old with a body mass index of 25.0 kg/m². The majority experienced symptoms for at least 4 months (91.4%), with 33.4% reporting symptoms lasting over 2 years. Symptoms were frequently exacerbated by athletic activities (86.6%) and sitting (63.8%). Prior to surgery, patients reported substantial functional limitations and impaired well-being, with a mean iHOT-12 score of 38.7 and a mHHS of 56.0. At 2-year follow-up, 85.9% and 76.4% of patients reached our distribution-based minimal clinically important difference value for mHHS and iHOT-12, respectively.
Conclusion
This multicenter data set has demonstrated improved patient-reported symptoms at the time of surgery, a decrease in mean patient BMI, and an increase in symptom duration reported prior to surgery. This data provides a contemporary benchmark for hip arthroscopy patient characteristics, reaffirms the efficacy of hip arthroscopy, and indicates earlier and more effective diagnosis of abnormal hip morphology.
{"title":"Lower body mass index and symptom burden in modern hip arthroscopy patients: Updated epidemiology and trends from the MASH multicenter cohort","authors":"Robert B. Baldwin, Samarth V. Menta, Mark Kurapatti, Dominic Carreira, Shane Nho, Andrew Wolff, John Christoforetti, John Salvo, Dean Matsuda, Anil S. Ranawat","doi":"10.1002/ksa.12745","DOIUrl":"10.1002/ksa.12745","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The present study aims to describe epidemiological, diagnostic and surgical data for a large group of patients undergoing hip arthroscopy between 2018 and 2023. We also explore how these trends compare to previous cohorts, particularly the 2014–2017 Multicenter Arthroscopic Study of the Hip (MASH) study. In response to the rapid growth of hip arthroscopy literature, we hypothesize that surgeons are operating on patients with a lower average body mass index (BMI), younger age, less severe reported symptoms at the time of surgery, and shorter preoperative symptom duration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The MASH database was searched for patients who underwent hip arthroscopy for treatment of FAI between 2018 and 2023, and had demographic data available in the registry. Standardized data included demographics, symptoms, imaging, intraoperative diagnoses (labral tears, cartilage lesions) and patient-reported outcome measures (International Hip Outcome Tool 12-item [iHOT-12], modified Harris Hip Score [mHHS], HOS, Visual Analogue Scale, 12-item Short Form Health Survey, Patient-Reported Outcomes Measurement Information System).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our study found that patients who elected to undergo hip arthroscopy between 2018 and 2023 at eight different US-based sites were, on average, 34.3 years old with a body mass index of 25.0 kg/m². The majority experienced symptoms for at least 4 months (91.4%), with 33.4% reporting symptoms lasting over 2 years. Symptoms were frequently exacerbated by athletic activities (86.6%) and sitting (63.8%). Prior to surgery, patients reported substantial functional limitations and impaired well-being, with a mean iHOT-12 score of 38.7 and a mHHS of 56.0. At 2-year follow-up, 85.9% and 76.4% of patients reached our distribution-based minimal clinically important difference value for mHHS and iHOT-12, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This multicenter data set has demonstrated improved patient-reported symptoms at the time of surgery, a decrease in mean patient BMI, and an increase in symptom duration reported prior to surgery. This data provides a contemporary benchmark for hip arthroscopy patient characteristics, reaffirms the efficacy of hip arthroscopy, and indicates earlier and more effective diagnosis of abnormal hip morphology.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 9","pages":"3405-3417"},"PeriodicalIF":5.0,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Takaaki Hiranaka, Christopher Davey, Samuel Grasso, Giacomo Dal Fabbro, Harbeer Ahedi, Brett Fritsch, David Parker
Purpose
Medial opening-wedge high tibial osteotomy (MOWHTO) correction error can result from either planning or execution, or both. This study aimed to (1) identify factors contributing to planning error, and (2) propose and evaluate a new planning method for reducing planning error.
Methods
A retrospective analysis was performed on 58 patients (mean age: 46.7 ± 7.2 years) with varus alignment who underwent MOWHTO using patient-specific implants. Radiographic measurements, including hip–knee–ankle angle (HKA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA) and knee joint line obliquity (KJLO), were made preoperatively and 6 months post-operatively. Overall error in HKA and surgical error in MPTA were used to calculate planning error (planning error = overall error − surgical error). A multivariable logistic regression analysis identified risk factors for suboptimal planning error (absolute error >1°), and this information was used to create a method to minimize it.
Results
Suboptimal planning error was associated with increased standing JLCA (3.9 ± 1.0° vs. 2.0 ± 1.4°; p < 0.001) and valgus KJLO (−0.6 ± 0.9° vs. 1.1 ± 2.5°; p = 0.005); however, multivariable logistic regression analysis identified increased standing JLCA as the only significant risk factor for suboptimal planning error (odds ratio: 3.27; p < 0.001). A preoperative JLCA cut-off of 2.8° yielded 94% sensitivity and 78% specificity for suboptimal planning error. Retrospective ΔJLCA adjustment, performed by subtracting ΔJLCA from post-operative HKA and recalculating planning error, reduced the mean planning error from 0.6 ± 1.0° to 0.2 ± 0.7° (p = 0.010).
Conclusion
Preoperative standing JLCA ≥ 2.8° is a significant risk factor for suboptimal planning in MOWHTO, with an increased risk of over-correction in these patients. The ΔJLCA method, which adjusts patient-specific planning by detecting joint laxity preoperatively using standing and supine images, may minimize planning error and improve post-operative alignment.
{"title":"A validated method accounting for joint line convergence angle reduces planning errors in medial opening wedge high tibial osteotomy","authors":"Takaaki Hiranaka, Christopher Davey, Samuel Grasso, Giacomo Dal Fabbro, Harbeer Ahedi, Brett Fritsch, David Parker","doi":"10.1002/ksa.12713","DOIUrl":"10.1002/ksa.12713","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Medial opening-wedge high tibial osteotomy (MOWHTO) correction error can result from either planning or execution, or both. This study aimed to (1) identify factors contributing to planning error, and (2) propose and evaluate a new planning method for reducing planning error.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis was performed on 58 patients (mean age: 46.7 ± 7.2 years) with varus alignment who underwent MOWHTO using patient-specific implants. Radiographic measurements, including hip–knee–ankle angle (HKA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA) and knee joint line obliquity (KJLO), were made preoperatively and 6 months post-operatively. Overall error in HKA and surgical error in MPTA were used to calculate planning error (planning error = overall error − surgical error). A multivariable logistic regression analysis identified risk factors for suboptimal planning error (absolute error >1°), and this information was used to create a method to minimize it.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Suboptimal planning error was associated with increased standing JLCA (3.9 ± 1.0° vs. 2.0 ± 1.4°; <i>p</i> < 0.001) and valgus KJLO (−0.6 ± 0.9° vs. 1.1 ± 2.5°; <i>p</i> = 0.005); however, multivariable logistic regression analysis identified increased standing JLCA as the only significant risk factor for suboptimal planning error (odds ratio: 3.27; <i>p</i> < 0.001). A preoperative JLCA cut-off of 2.8° yielded 94% sensitivity and 78% specificity for suboptimal planning error. Retrospective ΔJLCA adjustment, performed by subtracting ΔJLCA from post-operative HKA and recalculating planning error, reduced the mean planning error from 0.6 ± 1.0° to 0.2 ± 0.7° (<i>p</i> = 0.010).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Preoperative standing JLCA ≥ 2.8° is a significant risk factor for suboptimal planning in MOWHTO, with an increased risk of over-correction in these patients. The ΔJLCA method, which adjusts patient-specific planning by detecting joint laxity preoperatively using standing and supine images, may minimize planning error and improve post-operative alignment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV, retrospective case series.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 9","pages":"3341-3349"},"PeriodicalIF":5.0,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Total knee arthroplasty revision with primary implants: Could the kinematic alignment technique be a game changer?","authors":"Charles Riviere, Loïc Villet","doi":"10.1002/ksa.12794","DOIUrl":"10.1002/ksa.12794","url":null,"abstract":"","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 10","pages":"3454-3456"},"PeriodicalIF":5.0,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12794","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sabrina Böhle, Leandra Bauer, Matthias Woiczinski, Georg Matziolis
Purpose
Total knee arthroplasty (TKA) traditionally aims for neutral mechanical alignment (MA) to ensure implant longevity. However, this approach ignores individual knee variations, potentially leading to soft-tissue imbalances and suboptimal functional outcomes. As an alternative, personalised alignment techniques (PAT) have emerged that aim to restore bony anatomy, potentially improve soft tissue balance and thus accelerate recovery. Despite promising short-term results, long-term outcomes and regulatory approval remain unclear. This study investigates the extent to which TKA systems from various manufacturers are approved for kinematic alignment and allowable deviations from neutral MA.
Methods
TKA systems were identified using the 2020 Endoprosthesis Registry Germany (EPRD). Manufacturers were systematically contacted to determine if their implants were approved for deviations from neutral MA and the maximum permissible deviations. Follow-ups in 2021 and 2022 resulted in responses from 11 of 13 manufacturers, with an additional update in 2023 and 2025.
Results
Seven of twelve responding manufacturers either stated that their prostheses were not approved for MA deviations or did not specify details. Among the others, approval varied between implant systems. Two allowed deviations for specific implants without defined limits, while three specified allowable deviation ranges (Triathlon from Stryker with their Mako System 6° varus to 3° valgus; ATTUNE CR FB from Johnson & Johnson deviation 7° varus to 3° valgus°; ATTUNE PS FB and ATTUNE RP ± 3°; Primary system from Zimmer Biomet 0 ± 5° with their ROSA system). Revision systems universally restricted axis deviation due to mechanical constraints.
Conclusion
Only a limited number of manufacturers have conducted rigorous testing of their systems for deviations from MA, and consequently, are able to specify limits to such deviations. Additionally, practical limitations arise from the complexity of PAT, patient-specific factors and prosthesis suitability. To safeguard patient safety and ensure implant longevity, manufacturers should systematically evaluate alignment deviations through standardised tests or computational simulations.
{"title":"Are current total knee arthroplasty implants tested and approved for personalised alignment?","authors":"Sabrina Böhle, Leandra Bauer, Matthias Woiczinski, Georg Matziolis","doi":"10.1002/ksa.12783","DOIUrl":"10.1002/ksa.12783","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Total knee arthroplasty (TKA) traditionally aims for neutral mechanical alignment (MA) to ensure implant longevity. However, this approach ignores individual knee variations, potentially leading to soft-tissue imbalances and suboptimal functional outcomes. As an alternative, personalised alignment techniques (PAT) have emerged that aim to restore bony anatomy, potentially improve soft tissue balance and thus accelerate recovery. Despite promising short-term results, long-term outcomes and regulatory approval remain unclear. This study investigates the extent to which TKA systems from various manufacturers are approved for kinematic alignment and allowable deviations from neutral MA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>TKA systems were identified using the 2020 Endoprosthesis Registry Germany (EPRD). Manufacturers were systematically contacted to determine if their implants were approved for deviations from neutral MA and the maximum permissible deviations. Follow-ups in 2021 and 2022 resulted in responses from 11 of 13 manufacturers, with an additional update in 2023 and 2025.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seven of twelve responding manufacturers either stated that their prostheses were not approved for MA deviations or did not specify details. Among the others, approval varied between implant systems. Two allowed deviations for specific implants without defined limits, while three specified allowable deviation ranges (Triathlon from Stryker with their Mako System 6° varus to 3° valgus; ATTUNE CR FB from Johnson & Johnson deviation 7° varus to 3° valgus°; ATTUNE PS FB and ATTUNE RP ± 3°; Primary system from Zimmer Biomet 0 ± 5° with their ROSA system). Revision systems universally restricted axis deviation due to mechanical constraints.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Only a limited number of manufacturers have conducted rigorous testing of their systems for deviations from MA, and consequently, are able to specify limits to such deviations. Additionally, practical limitations arise from the complexity of PAT, patient-specific factors and prosthesis suitability. To safeguard patient safety and ensure implant longevity, manufacturers should systematically evaluate alignment deviations through standardised tests or computational simulations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>N/A.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 1","pages":"174-182"},"PeriodicalIF":5.0,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12747626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Moritz Herbst, Steffen Schröter, Atesch Ateschrang, Christoph Ihle, Felix Finger, Tina Histing, Stefan Döbele, Cornelius Fischer, Marc-Daniel Ahrend
Purpose
Double-level osteotomy (DLO) is a joint-preserving technique for the treatment of symptomatic varus knee osteoarthritis (OA) in cases of femoral and tibial combined deformity. The study aimed to investigate the mid-term survival rate (>5 years) and restoration of postoperative joint angles.
Methods
Sixty-five knees underwent DLO (medial open wedge high tibial osteotomy (MOWHT) and lateral closing wedge distal femoral osteotomy (LCWDFO) between 2011 and 2015. Minimum follow-up was 5 years. The survival rate was recorded and, in case of conversion to knee arthroplasty, the time of conversion. Radiographs were obtained preoperatively, 6 weeks postoperatively and at the last follow-up. On radiographs mechanical tibiofemoral angle (mTFA), mechanical medial proximal tibia angle (mMPTA), mechanical lateral distal femur angle (mLDFA), joint line convergence angle (JLCA) and joint line obliquity (JLO) were measured. The clinical outcome was measured using International Knee Documentation Committee (IKDC), Oxford and Lysholm score.
Results
Forty-nine knees (75% follow-up) were included after 8.0 ± 1.4 years. At the last follow-up, six knees underwent arthroplasty (7-year survival rate: 91.8%; 5-year survival rate: 93.9%) in average after 5.1 ± 2.3 years. Preoperatively, there was a varus deformity of −10.0 ± 2.5° (mTFA). In addition, pathologic knee joint angles with an mMPTA of 84.7 ± 2.2°, an mLDFA of 91.4 ± 2.1°, an JLCA of 3.4 ± 1.8 and a JLO of 3.0 ± 1.9°. Six weeks postoperatively mTFA was 0.7 ± 2.2° with values of mMPTA 91.0 ± 2.3°, mLDFA 86.8 ± 2.0° and JLO of 2.8 ± 2.1°. In the mid-term, a preserved leg axis (mTFA: −0.9 ± 2.7°) and preserved joint angles (mMPTA: 90.3 ± 2.7°, mLDFA: 87.1 ± 2.3°, JLCA: 4.3 ± 1.9 JLO: 3.2 ± 2.1°) were observed. At the last follow-up, the IKDC, Oxford Knee Score (OKS) and Lysholm score were: 61.2%, 36.1 points and 78.3 points, respectively.
Conclusion
The study demonstrates that DLO is an effective surgical technique to restore physiological joint angles in patients with severe preoperative deformity and symptomatic varus OA. Mid-term results indicate good clinical outcomes and a low conversion rate to TKA.
{"title":"Mid-term survival and physiological joint angles after double level osteotomy of severe varus osteoarthritis","authors":"Moritz Herbst, Steffen Schröter, Atesch Ateschrang, Christoph Ihle, Felix Finger, Tina Histing, Stefan Döbele, Cornelius Fischer, Marc-Daniel Ahrend","doi":"10.1002/ksa.12754","DOIUrl":"10.1002/ksa.12754","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Double-level osteotomy (DLO) is a joint-preserving technique for the treatment of symptomatic varus knee osteoarthritis (OA) in cases of femoral and tibial combined deformity. The study aimed to investigate the mid-term survival rate (>5 years) and restoration of postoperative joint angles.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Sixty-five knees underwent DLO (medial open wedge high tibial osteotomy (MOWHT) and lateral closing wedge distal femoral osteotomy (LCWDFO) between 2011 and 2015. Minimum follow-up was 5 years. The survival rate was recorded and, in case of conversion to knee arthroplasty, the time of conversion. Radiographs were obtained preoperatively, 6 weeks postoperatively and at the last follow-up. On radiographs mechanical tibiofemoral angle (mTFA), mechanical medial proximal tibia angle (mMPTA), mechanical lateral distal femur angle (mLDFA), joint line convergence angle (JLCA) and joint line obliquity (JLO) were measured. The clinical outcome was measured using International Knee Documentation Committee (IKDC), Oxford and Lysholm score.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Forty-nine knees (75% follow-up) were included after 8.0 ± 1.4 years. At the last follow-up, six knees underwent arthroplasty (7-year survival rate: 91.8%; 5-year survival rate: 93.9%) in average after 5.1 ± 2.3 years. Preoperatively, there was a varus deformity of −10.0 ± 2.5° (mTFA). In addition, pathologic knee joint angles with an mMPTA of 84.7 ± 2.2°, an mLDFA of 91.4 ± 2.1°, an JLCA of 3.4 ± 1.8 and a JLO of 3.0 ± 1.9°. Six weeks postoperatively mTFA was 0.7 ± 2.2° with values of mMPTA 91.0 ± 2.3°, mLDFA 86.8 ± 2.0° and JLO of 2.8 ± 2.1°. In the mid-term, a preserved leg axis (mTFA: −0.9 ± 2.7°) and preserved joint angles (mMPTA: 90.3 ± 2.7°, mLDFA: 87.1 ± 2.3°, JLCA: 4.3 ± 1.9 JLO: 3.2 ± 2.1°) were observed. At the last follow-up, the IKDC, Oxford Knee Score (OKS) and Lysholm score were: 61.2%, 36.1 points and 78.3 points, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The study demonstrates that DLO is an effective surgical technique to restore physiological joint angles in patients with severe preoperative deformity and symptomatic varus OA. Mid-term results indicate good clinical outcomes and a low conversion rate to TKA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 11","pages":"3963-3974"},"PeriodicalIF":5.0,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12754","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kristine Ifigenia Bunyoz, Martin Lindberg-Larsen, Kirill Gromov, Anders Troelsen
Purpose
Limited data and experience surround lateral unicompartmental knee arthroplasty (UKA), contributing to uncertainty regarding its broader application in clinical practice. To understand how to optimise lateral UKA outcomes, this study aimed to evaluate the implant survival of lateral UKA and compare it to total knee arthroplasty (TKA) using registry data.
Methods
Data were obtained from the Danish Knee Arthroplasty Registry, the Danish National Patient Registry and the Danish Civil Registration System. Between 1997 and 2022, all primary lateral UKAs (n = 538) and primary TKAs performed on valgus-aligned knees were included. Propensity score matching (1:4) matched patients by age, sex, weight, Charlson comorbidity index, year of surgery and hospital type. Survival analysis used the Fine-Gray subdistribution hazards model to account for competing risks.
Results
The 5-year cumulative revision risk was 10.1% for lateral UKA and 5.0% for TKA (1997–2022). For lateral UKA, this decreased from 25.0% (1997–2006) to 7.3% (2017–2022); TKA decreased from 4.6% to 3.7%. Surgery after 2011 and use of the fixed lateral Oxford (FLO) implant significantly reduced the risk of revision. Compared to TKA, the subdistribution hazard ratio for revision was 0.7 (95% confidence interval [CI] = 0.2–2.2) for the FLO implant and 3.4 (95% CI = 1.9–6.1) for other lateral UKAs in the period 2017–2022. No differences were found in 90-day readmissions or complications between lateral UKA and TKA, but the 2-year reoperation rate was significantly lower for lateral UKA in both periods.
Conclusion
Lateral UKA survival has evolved with improved understanding of knee compartment biomechanics, indications, surgical techniques and implant designs. Lateral UKA with the FLO implant showed lower or similar revision rates compared with TKA.
Level of Evidence
Level III.
目的：关于外侧单室膝关节置换术（UKA）的数据和经验有限，导致其在临床实践中的广泛应用存在不确定性。为了了解如何优化外侧UKA的结果，本研究旨在评估外侧UKA的植入物存活率，并使用注册数据将其与全膝关节置换术（TKA）进行比较。方法：数据来自丹麦膝关节置换术登记处、丹麦国家患者登记处和丹麦民事登记系统。在1997年至2022年期间，包括所有在外翻对准膝关节上进行的原发性外侧uka （n = 538）和原发性tka。倾向评分匹配（1:4）根据年龄、性别、体重、Charlson合并症指数、手术年份和医院类型进行匹配。生存分析使用Fine-Gray亚分布风险模型来解释竞争风险。结果：外侧UKA的5年累积翻修风险为10.1%，TKA的5年累积翻修风险为5.0%（1997-2022）。对于横向UKA，这一比例从25.0%（1997-2006年）下降到7.3%（2017-2022年）；TKA从4.6%下降到3.7%。2011年之后的手术和使用固定侧位牛津（FLO）种植体显著降低了翻修的风险。与TKA相比，2017-2022年期间，FLO植入物翻修的亚分布风险比为0.7(95%置信区间[CI] = 0.2-2.2)，其他侧位uka翻修的亚分布风险比为3.4 （95% CI = 1.9-6.1）。侧位UKA与TKA在90天再入院或并发症方面无差异，但两期的2年再手术率均明显低于侧位UKA。结论：随着对膝关节生物力学、适应症、手术技术和植入物设计的理解的提高，侧位UKA的生存率也在不断提高。与TKA相比，带FLO种植体的侧位UKA的翻修率更低或相似。证据等级：三级。
{"title":"Optimising outcomes in lateral unicompartmental knee arthroplasty: Analysing 25 years of registry data","authors":"Kristine Ifigenia Bunyoz, Martin Lindberg-Larsen, Kirill Gromov, Anders Troelsen","doi":"10.1002/ksa.12785","DOIUrl":"10.1002/ksa.12785","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Limited data and experience surround lateral unicompartmental knee arthroplasty (UKA), contributing to uncertainty regarding its broader application in clinical practice. To understand how to optimise lateral UKA outcomes, this study aimed to evaluate the implant survival of lateral UKA and compare it to total knee arthroplasty (TKA) using registry data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data were obtained from the Danish Knee Arthroplasty Registry, the Danish National Patient Registry and the Danish Civil Registration System. Between 1997 and 2022, all primary lateral UKAs (<i>n</i> = 538) and primary TKAs performed on valgus-aligned knees were included. Propensity score matching (1:4) matched patients by age, sex, weight, Charlson comorbidity index, year of surgery and hospital type. Survival analysis used the Fine-Gray subdistribution hazards model to account for competing risks.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The 5-year cumulative revision risk was 10.1% for lateral UKA and 5.0% for TKA (1997–2022). For lateral UKA, this decreased from 25.0% (1997–2006) to 7.3% (2017–2022); TKA decreased from 4.6% to 3.7%. Surgery after 2011 and use of the fixed lateral Oxford (FLO) implant significantly reduced the risk of revision. Compared to TKA, the subdistribution hazard ratio for revision was 0.7 (95% confidence interval [CI] = 0.2–2.2) for the FLO implant and 3.4 (95% CI = 1.9–6.1) for other lateral UKAs in the period 2017–2022. No differences were found in 90-day readmissions or complications between lateral UKA and TKA, but the 2-year reoperation rate was significantly lower for lateral UKA in both periods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Lateral UKA survival has evolved with improved understanding of knee compartment biomechanics, indications, surgical techniques and implant designs. Lateral UKA with the FLO implant showed lower or similar revision rates compared with TKA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level III.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 12","pages":"4324-4334"},"PeriodicalIF":5.0,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12785","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mohammad Kamal Abdelnasser, Ayat Bakhet, Mahmoud Elagramy, Mohammed Anter Abdelhameed
<div> <section> <h3> Purpose</h3> <p>Several serum biomarkers have been used to aid in the diagnosis of periprosthetic joint infection (PJI) including platelet count/mean platelet volume ratio (PC/MPV) and neutrophil to lymphocyte ratio (NLR). The purpose of this study is to report the diagnostic performance of the serum markers NLR and PC/MPV in periprosthetic joint infection and to compare these markers with other already established serum biomarkers such as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and other synovial biomarkers as synovial white blood cell counts (WBCs), polymorphonuclear leucocyte percentage (PMN%), leucocyte esterase and synovial culture.</p> </section> <section> <h3> Methods</h3> <p>This is a single centre prospective cohort study in which all patients with painful hip or knee arthroplasty presented to our clinic, whether they underwent a revision surgery or not, were evaluated for eligibility. Out of 145 patients with painful hip or knee arthroplasty that were evaluated, 35 patients were excluded leaving 110 patients with eligible for this study. Blood samples were taken within a week before the revision surgery or aspiration to obtain the following parameters: ESR, CRP, WBCs, NLR, PC, MPV and PC/MPV. The modified Musculoskeletal Infection Society (MSIS) criteria were set as the gold standard test for diagnosis of per PJI in the study.</p> </section> <section> <h3> Results</h3> <p>According to the MSIS criteria, 48 of them were septic and 62 were aseptic. The diagnostic accuracy of the new serum markers was lower than that of the traditional markers. Receiver-operator characteristic (ROC) curve analysis for the NLR showed an area under the curve (AUC) of 0.556 with <i>p</i>-Value = 0.321, for the PC/MPV showed an AUC of 0.586 with <i>p</i>-Value = 0.129 while that for ESR showed an AUC of 0.688 with <i>p</i>-Value = 0.001 and that for CRP showed an AUC of 0.778 with <i>p</i>-Value < 0.001. To determine whether adding each of NLR and PC/MPV to the traditional serum markers (ESR + CRP) would increase the diagnostic performance of these markers or not, we compared the four models: (1) ESR + CRP, (2) ESR + CRP + NLR, (3) ESR + CRP + PC/MPV and (4) ESR + CRP + NLR + PC/MPV. There was no significant difference between the four models in AUC which shows that no added value of using the new serum markers.</p> </section> <section> <h3> Conclusion</h3> <p>Traditional serum markers (ESR and CRP) still have the best diagnostic performance in the diagnosis of PJI even when compared to the newer markers such as NLR and PC/MPV, which show limited added value either alone or when combined with ESR +
{"title":"No added value of the neutrophil-lymphocyte ratio and platelet count to mean platelet volume ratio over the traditional serum markers (erythrocyte sedimentation rate and C-reactive protein) in the diagnosis of periprosthetic joint infection","authors":"Mohammad Kamal Abdelnasser, Ayat Bakhet, Mahmoud Elagramy, Mohammed Anter Abdelhameed","doi":"10.1002/ksa.12768","DOIUrl":"10.1002/ksa.12768","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Several serum biomarkers have been used to aid in the diagnosis of periprosthetic joint infection (PJI) including platelet count/mean platelet volume ratio (PC/MPV) and neutrophil to lymphocyte ratio (NLR). The purpose of this study is to report the diagnostic performance of the serum markers NLR and PC/MPV in periprosthetic joint infection and to compare these markers with other already established serum biomarkers such as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and other synovial biomarkers as synovial white blood cell counts (WBCs), polymorphonuclear leucocyte percentage (PMN%), leucocyte esterase and synovial culture.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a single centre prospective cohort study in which all patients with painful hip or knee arthroplasty presented to our clinic, whether they underwent a revision surgery or not, were evaluated for eligibility. Out of 145 patients with painful hip or knee arthroplasty that were evaluated, 35 patients were excluded leaving 110 patients with eligible for this study. Blood samples were taken within a week before the revision surgery or aspiration to obtain the following parameters: ESR, CRP, WBCs, NLR, PC, MPV and PC/MPV. The modified Musculoskeletal Infection Society (MSIS) criteria were set as the gold standard test for diagnosis of per PJI in the study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>According to the MSIS criteria, 48 of them were septic and 62 were aseptic. The diagnostic accuracy of the new serum markers was lower than that of the traditional markers. Receiver-operator characteristic (ROC) curve analysis for the NLR showed an area under the curve (AUC) of 0.556 with <i>p</i>-Value = 0.321, for the PC/MPV showed an AUC of 0.586 with <i>p</i>-Value = 0.129 while that for ESR showed an AUC of 0.688 with <i>p</i>-Value = 0.001 and that for CRP showed an AUC of 0.778 with <i>p</i>-Value < 0.001. To determine whether adding each of NLR and PC/MPV to the traditional serum markers (ESR + CRP) would increase the diagnostic performance of these markers or not, we compared the four models: (1) ESR + CRP, (2) ESR + CRP + NLR, (3) ESR + CRP + PC/MPV and (4) ESR + CRP + NLR + PC/MPV. There was no significant difference between the four models in AUC which shows that no added value of using the new serum markers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Traditional serum markers (ESR and CRP) still have the best diagnostic performance in the diagnosis of PJI even when compared to the newer markers such as NLR and PC/MPV, which show limited added value either alone or when combined with ESR +","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 12","pages":"4244-4254"},"PeriodicalIF":5.0,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Antonio Klasan, Dragan Jeremic, Thomas Neri, Thomas Jan Heyse, Michael T. Hirschmann
Purpose
Functional alignment (FA) aims to achieve a symmetric, rectangular extension gap and a rectangular or trapezoidal flexion gap, positioning the components in a manner that reduces the compromises to the soft tissue envelope. Because the FA surgeon can accomplish this goal with a multitude of adjustments to the components' position or soft tissue balance, the purpose of the present study was to analyze the possible paths for achieving FA.
Methods
Ten knees undergoing robotic total knee arthroplasty (TKA) were analyzed. Based on the intraoperatively acquired data, a macro was created to perform a post hoc analysis of the 10 possible paths to align a TKA functionally: (1) starting from mechanical alignment (MA) or kinematic alignment (KA), (2) preserving either the position of the femoral or tibial component and (3) with equal, 1 mm gaps or with increased 90° lateral flexion laxity.
Results
Ten different knee phenotypes were analyzed (Var-Neu-Neu 2x; Neu-Neu-Val; Val-Val-Val; Neu-Val-Neu; Var-Neu-Var 3x; Var-Var-Var; Var-Var-Val). On average, 3.5 different paths resulted in FA for each TKA (range: 0–8). Two TKAs (Val-Val-Val; Var-Var-Val) could not be functionally aligned using any of the ten evaluated paths. One TKA could be functionally aligned using eight different paths.
Conclusion
Functionally aligning a TKA can be achieved through multiple adjustments, resulting in various implant positions and soft tissue balances. To better understand the different combinations behind FA, a more detailed nomenclature is needed, including which initial alignment (MA or KA) was utilized, which component's position (femoral or tibial) was preserved, and whether a rectangular or trapezoidal flexion space was targeted.
{"title":"Functional alignment in total knee arthroplasty is an umbrella term—A call for better definition and reporting quality!","authors":"Antonio Klasan, Dragan Jeremic, Thomas Neri, Thomas Jan Heyse, Michael T. Hirschmann","doi":"10.1002/ksa.12774","DOIUrl":"10.1002/ksa.12774","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Functional alignment (FA) aims to achieve a symmetric, rectangular extension gap and a rectangular or trapezoidal flexion gap, positioning the components in a manner that reduces the compromises to the soft tissue envelope. Because the FA surgeon can accomplish this goal with a multitude of adjustments to the components' position or soft tissue balance, the purpose of the present study was to analyze the possible paths for achieving FA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Ten knees undergoing robotic total knee arthroplasty (TKA) were analyzed. Based on the intraoperatively acquired data, a macro was created to perform a post hoc analysis of the 10 possible paths to align a TKA functionally: (1) starting from mechanical alignment (MA) or kinematic alignment (KA), (2) preserving either the position of the femoral or tibial component and (3) with equal, 1 mm gaps or with increased 90° lateral flexion laxity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ten different knee phenotypes were analyzed (Var-Neu-Neu 2x; Neu-Neu-Val; Val-Val-Val; Neu-Val-Neu; Var-Neu-Var 3x; Var-Var-Var; Var-Var-Val). On average, 3.5 different paths resulted in FA for each TKA (range: 0–8). Two TKAs (Val-Val-Val; Var-Var-Val) could not be functionally aligned using any of the ten evaluated paths. One TKA could be functionally aligned using eight different paths.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Functionally aligning a TKA can be achieved through multiple adjustments, resulting in various implant positions and soft tissue balances. To better understand the different combinations behind FA, a more detailed nomenclature is needed, including which initial alignment (MA or KA) was utilized, which component's position (femoral or tibial) was preserved, and whether a rectangular or trapezoidal flexion space was targeted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV, therapeutic study.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 12","pages":"4275-4281"},"PeriodicalIF":5.0,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12774","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Stephen M. Howell, Ahmed Zabiba, Patrick Sadoghi, Alexander J. Nedopil, Maury L. Hull
Purpose
Kinematic alignment (KA) total knee arthroplasty (TKA) aligns the femoral component to restore the pre-arthritic posterior joint line, potentially altering the heights of the medial and lateral trochlear peaks. It remains unclear whether the femoral component should be adjusted to correct deviations in peak height. This study assessed whether >2 mm of under- or over-stuffing in peak height negatively impacted patient-reported outcome (PRO) scores compared to restoration within ±2 mm.
Methods
The study included 115 KA TKAs performed with a KA-optimized femoral component featuring a trochlea with a lateral ridge opening that creates a 20° valgus trochlear groove and a flattened medial ridge, and PROs at a mean of 22 (12–28) months. The surgeon measured the height of the trochlear peaks on the anterior femoral resection.
Results
Peak under-stuffing >2 mm occurred medially in 66% and laterally in 43%. Over-stuffing >2 mm was too infrequent for statistical analysis. Compared to restoration within ±2 mm, medial under-stuffing resulted in a non-equivalent 6-point higher Forgotten Joint Score (FJS) (p = 0.1087) and equivalent but 9- and 3-point higher Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) (p < 0.0001) and Oxford Knee Score (OKS) (p = 0.0020). Lateral under-stuffing yielded equivalent but 6-, 12- and 3-point higher FJS (p = 0.0484), KOOS JR (p < 0.0001) and OKS (p < 0.0001).
Conclusion
The KA-optimized femoral component features a patient-specific trochlea that addresses anterior arthritic trochlear variations, which are reported to range from −24° varus to 30° valgus. One possible explanation for why >2 mm of under-stuffing leads to superior PROs is that reducing the peak height compensates for over-stuffing above the native trochlea caused by the prosthesis's proximal overreach, with a reported average of 17 mm.
{"title":"Restoration of the trochlear peaks is unnecessary with a kinematic alignment-optimized femoral component as under-stuffing results in equivalent or better patient-reported outcome scores","authors":"Stephen M. Howell, Ahmed Zabiba, Patrick Sadoghi, Alexander J. Nedopil, Maury L. Hull","doi":"10.1002/ksa.12777","DOIUrl":"10.1002/ksa.12777","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Kinematic alignment (KA) total knee arthroplasty (TKA) aligns the femoral component to restore the pre-arthritic posterior joint line, potentially altering the heights of the medial and lateral trochlear peaks. It remains unclear whether the femoral component should be adjusted to correct deviations in peak height. This study assessed whether >2 mm of under- or over-stuffing in peak height negatively impacted patient-reported outcome (PRO) scores compared to restoration within ±2 mm.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study included 115 KA TKAs performed with a KA-optimized femoral component featuring a trochlea with a lateral ridge opening that creates a 20° valgus trochlear groove and a flattened medial ridge, and PROs at a mean of 22 (12–28) months. The surgeon measured the height of the trochlear peaks on the anterior femoral resection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Peak under-stuffing >2 mm occurred medially in 66% and laterally in 43%. Over-stuffing >2 mm was too infrequent for statistical analysis. Compared to restoration within ±2 mm, medial under-stuffing resulted in a non-equivalent 6-point higher Forgotten Joint Score (FJS) (<i>p</i> = 0.1087) and equivalent but 9- and 3-point higher Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) (<i>p</i> < 0.0001) and Oxford Knee Score (OKS) (<i>p</i> = 0.0020). Lateral under-stuffing yielded equivalent but 6-, 12- and 3-point higher FJS (<i>p</i> = 0.0484), KOOS JR (<i>p</i> < 0.0001) and OKS (<i>p</i> < 0.0001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The KA-optimized femoral component features a patient-specific trochlea that addresses anterior arthritic trochlear variations, which are reported to range from −24° varus to 30° valgus. One possible explanation for why >2 mm of under-stuffing leads to superior PROs is that reducing the peak height compensates for over-stuffing above the native trochlea caused by the prosthesis's proximal overreach, with a reported average of 17 mm.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level III.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 12","pages":"4291-4302"},"PeriodicalIF":5.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12777","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144577571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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